Type 2 Diabetes Mellitus Management
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Questions and Answers

Based on his immunization history, which vaccinations should be recommended for the patient today? (Select 2 that apply)

  • Pneumococcal vaccine (correct)
  • Influenza vaccine
  • Zoster vaccine (correct)
  • Tetanus and diphtheria (Td)

Delirium is a chronic, progressive cognitive decline.

False (B)

Which medication is typically the most appropriate initial choice for treating Alzheimer's disease in an older adult?

  • Memantine
  • Lorazepam
  • Donepezil (correct)
  • Haloperidol

What is the primary benefit offered by cholinesterase inhibitors in managing dementia?

<p>Symptomatic relief</p> Signup and view all the answers

Which test provides information on the functional performance of complex activities in an elderly patient presenting with memory problems?

<p>Functional Activities Questionnaire (FAQ) (A)</p> Signup and view all the answers

Assessing gait and balance is ______ included as part of the nurse practitioner's assessment for Alzheimer's disease.

<p>typically</p> Signup and view all the answers

What initial tests are appropriate when evaluating a patient for dementia? (Select three that apply.)

<p>Thyroid-Stimulating Hormone (TSH) (B), Serum Vitamin B12 level (C), Complete Blood Count (CBC) (D)</p> Signup and view all the answers

A 60-year-old patient with moderate cognitive deficits due to Alzheimer's disease has been started on a cholinesterase inhibitor. What is the primary purpose of this drug?

<p>To improve cognitive function and daily living activities (D)</p> Signup and view all the answers

A patient presents with a high TSH and normal T4 levels. What is the most appropriate diagnosis?

<p>Subclinical hypothyroidism (C)</p> Signup and view all the answers

Which findings are diagnostic criteria for type 2 diabetes? (Select 3 that apply)

<p>2-hour plasma glucose ≥ 200 mg/dL during an oral glucose tolerance test (A), A1C ≥ 6.5% (B), Fasting plasma glucose ≥ 126 mg/dL (C)</p> Signup and view all the answers

Meglitinide analogs (Prandin) are used in type 2 diabetes mellitus care to minimize the risk of which condition?

<p>Hypoglycemia (A)</p> Signup and view all the answers

A 40-year-old patient with newly diagnosed type 2 diabetes mellitus is on metformin 1000 mg BID. His latest HbA1c is 8.1%. What is the appropriate next step?

<p>Add a different class of oral hypoglycemic medication, like a DPP-4 inhibitor or SGLT2 inhibitor. (B)</p> Signup and view all the answers

A thiazolidinedione (TZD) is safe to prescribe to a patient with a history of heart failure.

<p>False (B)</p> Signup and view all the answers

A 55-year-old patient with type 2 diabetes mellitus is on maximal doses of two oral medications. His HbA1c is 9.8%, and his weight is 120 kg. What is the most appropriate next step in managing his diabetes?

<p>Start daily insulin injections. (A)</p> Signup and view all the answers

A fasting blood glucose of 285 mg/dL is adequate to diagnose a patient with type 2 diabetes.

<p>True (A)</p> Signup and view all the answers

A 45-year-old patient with a 5-year history of diabetes mellitus is currently managed with metformin. His fasting glucose levels are elevated, and his latest HbA1c is 8.2%. Which of the following medications is least likely to be considered as an add-on therapy, considering potential side effects and contraindications?

<p>Thiazolidinedione (TZD) (B)</p> Signup and view all the answers

Dan, a 45-year-old obese patient with type 2 diabetes mellitus, is struggling to control his HbA1c. He has heard that GLP-1 receptor agonists like Byetta can cause weight loss. As a provider, what is a key counseling point regarding the use of GLP-1 receptor agonists?

<p>The patient should be counseled that while GLP-1 receptor agonists can promote weight loss, they are also administered via subcutaneous injection.</p> Signup and view all the answers

A newly diagnosed type 1 diabetes mellitus patient weighing 120 kg will be started on insulin therapy. An appropriate initial total daily dose estimate would be approximately ______ units.

<p>60</p> Signup and view all the answers

Which of the following tests is the LEAST useful in the initial evaluation of a patient recently diagnosed with type 2 diabetes mellitus?

<p>Anti GAD antibody test (B)</p> Signup and view all the answers

Match the intervention with its related goal for microalbuminuria in a person with diabetes.

<p>ACE inhibitors or ARBs = Reduce intraglomerular pressure Blood pressure control = Reduce mechanical stress on the kidneys Glycemic control = Reduce glomerular damage from hyperglycemia Dietary sodium restriction = Lower blood pressure</p> Signup and view all the answers

Flashcards

Meglitinide Analogs Use

Medications that help reduce post-meal blood sugar spikes.

Next Step After Metformin Inadequacy

If HbA1c is not at target with metformin, add another medication.

TZD Prescription Considerations

TZDs should be prescribed with caution and closely follow up with the provider.

Next Step After Maximizing Oral Meds

When a patient is on maximal oral medications and HbA1c is high, consider injectable therapies or insulin.

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Symptoms and High Glucose

This is highly suggestive of diabetes, but diagnostic testing is required to confirm.

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Choosing Second Oral Medication

Medication choice depends on patient-specific factors.

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GLP-1 Receptor Agonists

GLP-1 agonists can help with weight loss and glycemic control.

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Initial Insulin Dose (Type 1)

Typical initial dose is 0.5 units/kg/day, divided into basal and bolus doses.

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Differentiating DM Types

C-peptide levels can help differentiate between type 1 and type 2 diabetes.

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Beers Criteria (Hypertension)

Avoid prescribing multiple medications for the same condition.

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Delirium

An acute disturbance in attention and awareness, with changes in cognition that develop over a short period (hours to days) and tend to fluctuate.

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Cholinesterase Inhibitors for Alzheimer's

Cholinesterase inhibitors increase acetylcholine levels in the brain, which can temporarily improve cognitive function and memory.

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Benefits of Cholinesterase Inhibitors in Dementia

Cholinesterase inhibitors can improve cognition, behavior, and overall function in patients with dementia, but their effects are modest and temporary.

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Functional Assessment in Memory Problems

An assessment that evaluates the patient's ability to perform activities necessary for independent living, such as managing finances, medications, and transportation.

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Purpose of Cholinesterase Inhibitors in Alzheimer’s

The primary goal is to temporarily improve cognitive deficits and manage behavioral symptoms to enhance the patient's quality of life.

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High TSH, Normal T4

This indicates subclinical hypothyroidism, where the thyroid is working harder to produce normal T4 levels.

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Study Notes

  • Meglitinide analogs (Prandin) are helpful in type 2 diabetes mellitus care to minimize the risk of hypoglycemia.
  • For a 40-year-old newly diagnosed type 2 DM patient on Metformin 1000mg BID with HbA1c of 8.1%, consider adding another medication to Metformin.
  • A TZD drug can be prescribed to a patient that does not have heart failure.
  • For a 55-year-old type 2 DM patient on maximum dose of two oral medications with HbA1c of 9.8% and weight of 120 kg, insulin therapy should be started.
  • A 38-year-old female with a strong family history of type 2 DM presents with polydipsia, polyuria, and polyphagia and a fasting blood glucose of 285, which is diagnostic of diabetes.
  • For a 45-year-old patient who has been diabetic for five years, is on metformin, but whose fasting glucose has been elevated and HbA1c is 8.2%, a sulfonylurea medication is likely not to be added.
  • For a 45-year-old obese patient with type 2 DM having difficulty controlling HbA1c and who has heard that GLP-1 receptor agonists (Byetta) cause weight loss, GLP-1 agonists promote weight loss and lower blood glucose.
  • A newly diagnosed type 1 DM patient weighing 120 kg will be started on an initial insulin dose of 0.5 units/kg/day.
  • When a patient has been recently diagnosed with DM type 2, C-peptide level is the least useful in the initial evaluation.
  • Interventions for microalbuminuria in a person with DM includes ACE inhibitors or ARBs.
  • Testing to differentiate type 1 and type 2 DM is islet cell antibodies.
  • For a 68-year-old woman with no major concerns, chronic health problems, or significant medical history, age-based screening to recommend includes:
    • Mammogram
    • Colonoscopy
    • Bone mineral density

Mr. Stevens Case

  • Mr. Stevens, a 72-year-old male with hypertension, is on amlodipine 5 mg daily, lisinopril 5 mg daily, and enalapril 5 mg daily.
  • The Beers criteria is applicable to Mr. Stevens's regimen, which would prompt consideration of stopping one medication.

Bill's Immunization

  • Bill is a 67-year-old male needing immunizations.
  • Recommended immunizations include:
    • Recombinant zoster vaccine
    • Pneumococcal vaccine

Delirium vs. Dementia

  • Delirium differs from dementia because delirium has a sudden onset.
  • When treating an older adult male for Alzheimer's disease, the primary care nurse practitioner to describe Donepezil is an appropriate initial choice.
  • Cholinesterase inhibitors, such as Donepezil, offer the greatest benefit in improving cognitive function, behavior, and overall function in managing dementia.
  • An appropriate test for the initial assessment of an elderly patient presenting with memory problems that provides information on functional performance of more complex activities is the Assessment of Instrumental Activities of Daily Living.
  • Assessing the patient's driving ability is not included as part of the nurse practitioner's assessment for Alzheimer's disease.
  • In evaluating a patient for dementia, appropriate initial tests include:
    • Vitamin B12 level
    • TSH
    • Complete blood count (CBC)
  • In a 60-year-old patient with moderate cognitive deficit attributed to Alzheimer's disease, which has been started on a Cholinesterase inhibitor. The purpose of this drug is to preserve cognitive function.
  • A patient with a high TSH and normal T4 has subclinical hypothyroidism.

Type 2 Diabetes Diagnosis Criteria

  • Criteria for the diagnosis of type 2 diabetes include:
    • Hemoglobin A1C > 6.5%
    • Fasting plasma glucose > 126 mg/dL
    • Two-hour plasma glucose > 200 mg/dL during an oral glucose tolerance test

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Description

This lesson covers key aspects of managing Type 2 Diabetes Mellitus. Topics include medication choices, treatment adjustments based on HbA1c levels, and diagnostic criteria. It provides guidance on when to consider insulin therapy and other treatment options.

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